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18 FDG PET imaging in dilated cardiomyopathy: correlation with disease severity, 2D strain echo and magnetic resonance imaging

Session New roles for cardiac imaging 2018: state of the art

Speaker Nicolas Piriou

Event : EuroEcho 2018

  • Topic : imaging
  • Sub-topic : Positron Emission Tomography (PET)
  • Session type : Moderated Posters

Authors : M Vivien (Nantes,FR), A Pallardy (Nantes,FR), T Eugene (Nantes,FR), B Guyomarch (Nantes,FR), JM Serfaty (Nantes,FR), JN Trochu (Nantes,FR), N Piriou (Nantes,FR)

M Vivien1 , A Pallardy2 , T Eugene2 , B Guyomarch1 , JM Serfaty3 , JN Trochu1 , N Piriou2 , 1l'Institut du thorax, University Hospital of Nantes - Nantes - France , 2University Hospital, Nuclear Medicine Department - Nantes - France , 3University Hospital of Nantes, Cardiac and vascular radiology - Nantes - France ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 1 ), i283

Background : 
Cardiac positon emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is commonly used to detect myocardial inflammation, assess prognosis and guide therapy in patients with cardiac sarcoidosis (CS). Few data exist about FDG-PET pattern in other cardiomyopathies and its relation with disease severity and myocardial remodeling.
Purpose : 
The goal of this study was to describe the different patterns observed in cardiac 18F-FDG PET imaging during the initial evaluation of patients with newly diagnosed dilated cardiomyopathy (DCM), and to compare these findings with magnetic resonance imaging (MRI) and echocardiographic data, as well as clinical data obtained after one year follow up.
Methods and Results :
Thirty consecutive DCM patients were explored by cardiac FDG PET after high fat-low carbohydrates diet and prolonged fasting during the initial work up. Compared to eleven patients with active myocardial inflammation in a context of cardiac sarcoidosis (CS), FDG uptake pattern was significantly different in DCM patients, with a lower intensity and a lower heterogeneity of myocardial uptake (Maximal myocardial Standardized Uptake Value was 4,79 ± 2,42 in DCM patients vs 8,90 ± 4,32 in CS (p = 0,003); Coefficient of FDG uptake variation was 0,20 ± 0,09 in DCM versus 0,38 ± 0,16 in CS (p< 0,001)). Twenty DCM patients (66.7%) had a significant myocardial FDG uptake on a qualitative evaluation, 8 of which had focal or focal on diffuse uptake (27%) and 12 had diffuse uptake (40%). Patients with diffuse FDG uptake had a significantly lower left ventricular ejection fraction (LVEF) than patients without uptake (25 ±  11 % vs 35 ± 9 %, p = 0,02). At one year follow-up, none of the no FDG uptake patients had had a cardiovascular event, and LVEF increase tended to be better in this subgroup than in diffuse or focal or focal on diffuse patients. There was a significant correlation between moderate and severe FDG uptake intensity and the presence of late gadolinium enhancement (LGE) in the 322 myocardial segments available for analysis on MRI (p=0,02). Among the 302 segments available for 2-dimensional longitudinal strain echocardiographic analysis, there was a significant correlation between strain alteration and FDG uptake intensity in the subgroup of patients with focal and focal on diffuse uptake in PET (r = 0,258, p = 0,005; see Figure).
Conclusions : 
Despite a different pattern than that observed in CS, FDG PET imaging seems to be of interest in the initial work up of DCM. Focal FDG uptake is correlated to the presence of segmental LGE and to a regional alteration of longitudinal strain,  and diffuse uptake pattern is observed in more depressed LV function. Further studies are needed to evaluate the prognostic significance of these findings.

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